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The thought of a total hip replacement, or any surgery, can be extremely overwhelming. With so much information on the internet, it can be difficult to reign it all in and know what is truly useful. We’ve taken the guesswork out of it for you by synthesizing everything you need to know about the total hip replacement process in one place!
What Does a Hip Replacement Mean?
There are two main types of hip replacements, a total hip replacement (THR) and a partial hip replacement. A THR is the most common type, which is when the entire hip joint is replaced with a new prosthetic joint. A partial hip replacement involves only removing and replacing one side of the hip joint (typically the femoral side, which is the big bone in your upper thigh that connects to the pelvis) while preserving the other. In this article, we will focus on the THR, also formally known as a total hip arthroplasty (THA).
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Common Reasons for a THR
The most common reason for a THR is osteoarthritis of the hip joint, when the protective cartilage within the joint wears away causing pain and inflammation to the joint. For more information on osteoarthritis, check out our article Arthritis 101. Other reasons for THR include injury or trauma resulting in fracture, osteonecrosis to the femoral head, bone deformities from birth, and other types of inflammatory arthritis.
Benefits of a THR Surgery
THR are extremely common surgeries with great success rates and outcomes that can significantly improve the quality of life of individuals struggling with hip pain and impaired functional mobility. After recovering from surgery, patients usually report decreased hip pain, better hip mobility, and an easier time performing hobbies and daily activities. For those diagnosed with advanced osteoarthritis, a THR can be a solution if their pain and function is not improved upon with conservative treatment.
Do I need THR surgery?
While surgery is an option, not everyone with hip osteoarthritis will need to have a THR. The American Academy of Orthopedic Surgeons endorses the use of non-operative measures to manage hip osteoarthritis prior to surgery. Of these measures, physical therapy and physical activity in general hold particular importance. A physical therapist can design customized exercise programs to strengthen target muscle groups, provide patient education on proper body mechanics and pain management, and assist with adding in daily physical activity. These methods have been shown to be an effective way at managing hip pain from osteoarthritis in the earlier stages and prevent further progression.
How to prepare for THR surgery?
Like any surgery, having a plan and taking time to prepare yourself beforehand will make your life a bit less hectic after the surgery so that you can focus on healing. Make sure before surgery, you set your home environment up for success so it’s one less thing to worry about. Check out our 5 tips to prepare your home before hip surgery! It’s also important to talk with your family and establish a support system to get the help you may need such as rides to appointments, taking care of pets, and household chores or cooking.
Total Hip Replacement: The Actual Surgery
The two most common approaches to THR surgeries are called posterior and anterior approaches. Each approach has its own pros and cons, so your surgeon will determine which is best for your unique situation based on a variety of factors.
Posterior Approach
This is the most common approach, and traditionally involves an incision to the posterior (backside) of the hip, through the buttocks muscles. A major benefit of this approach is that it spares the hip abductors, which are an important muscle group involved in stabilizing the pelvis during walking.
Anterior Approach
This approach is growing in popularity amongst surgeons. It involves an incision in the front of the hip, but because of the way the muscles are, surgeons are able to push the muscles aside to expose the hip joint with minimal to no cutting of the muscles.
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What To Expect After Your Hip Joint Replacement Surgery
What are the goals after a THR?
After a THR, you and your physical therapist will work together to improve your hip strength and range of motion within any surgical precautions. It is important for you to not only restore muscle strength, but adequate muscle control and coordination as well. Your physical therapist will help improve your gait, or ability to walk, without an assistive device. The goal is to restore an efficient walking pattern, free of deviations and pain as much as possible. Negotiating curbs and climbing stairs with ease will also be the focus of post-op treatment. Additionally, balance training will enhance your stability and confidence with more dynamic tasks as well as reduce the risk of future falls. It is important for physical therapy to be only the beginning of an active lifestyle to help you stay mobile for the long term.
What movements should I avoid after THR surgery?
With each type of surgical approach, there are specific surgical precautions you need to follow that involve avoiding certain movements to allow the new hip to heal and prevent dislocation. In general, do not cross your legs over each other, sit in low chairs, sit for prolonged periods of time, or sleep on your operative side. Additionally, it is important to be consistent with your exercises to improve strength and reduce your risks of falls which will protect your new joint as it’s healing.
How soon can I return to regular activities like walking, climbing stairs, and driving?
In our article, 7 Questions to Ask Your Surgeon After Hip Replacement Surgery, we compiled a list of great questions for you to make sure are answered by your surgeon so you feel confident in your recovery. Overall, you should be able to resume most of your light daily activities within 3-6 weeks after your surgery.
You will be able to walk as soon as you are out of surgery, although you will likely use an assistive device of some sort such as a walker. Your physical therapist will work with you to progress your gait and decrease the use of assistive devices as it is appropriate. You will likely practice ascending and descending stairs with your therapist before leaving the hospital, especially if you have stairs to negotiate at home to make sure you are safe to do so. Depending on how you do, your therapist may recommend limiting stair use or only doing so with the help of someone else until you are able to practice more in therapy and gain some of your strength back. It is very normal for stairs to be difficult after surgery, which is why your physical therapist will work with you so that it becomes easier and more comfortable as you progress. In the meantime, being mindful to go up stairs with your “good,” or non-operative leg, and down stairs with your “bad,” or operative leg, will keep most of your weight on the non-operative side throughout, providing you with more stability and minimizing pain.
Learn the right way to negotiate stairs with our PT, Stephanie Wakeman:
For more useful information on post-op recovery, tips and insights, be sure to check out our YouTube channel.
Returning to driving depends on many factors, such as the type of car you drive and which leg was operated on. However, typically patients can expect to return to driving around 6 weeks after surgery, but definitely get the go-ahead from your surgeon first.
For more information on when it’s okay to return to more intimate activities, check out our article, Sex After Hip Replacement Surgery.
When can I return to sports after THR surgery?
It’s important to work closely with your physical therapist and surgeon when returning to sport after a THR. As you get stronger, you will gradually be able to resume physical activity, starting with lower impact activities such as cycling, golfing, swimming, and hiking. The entire recovery process can take up to 6-12 months, but most people will notice they are back to the majority of their typical routine around 6-12 weeks after surgery.
Considering your options for managing your hip pain? Download the OneStep Digital Physical Therapy app to consult with a licensed physical therapist who will assess your needs, create a treatment program for you, and work with you to decide along with your other medical providers if and when THR surgery is appropriate.
References:
Varacallo M, Luo TD, Johanson NA. Total Hip Arthroplasty Techniques. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: updated February 12, 2022. Accessed March 9, 2022.
Total Hip Replacement. OrthoInfo from the American Academy of Orthopedic Surgeons. Updated June 2020. Accessed March 9, 2022.
Hip Replacement. Mayo Clinic. Updated August 2021. Accessed March 9, 2022.
